Definition of Infertility
Infertility is defined as not being able to become pregnant after at least one year of unprotected sexual intercourse. Infertility is a medical condition that is found in men and women. Several factors may cause infertility in female and male as listed below:
Female Factor
- Ovulation dysfunction (hormonal disorder)
- Anatomical problem
- Endometriosis
- Infection
- Immunological problems
Male Factor
- Low or absent sperm production
- Abnormal sperm function
- Varicocele
- Lifestyle
- Hormonal disorder
- Immunological problems
Hormonal disorder is reported as primary cause of infertility.
What is hormone?
Hormone is a chemical substance released by an endocrine gland into the blood circulation that controls and regulates the activity of cells or organs.Hormones act on their respective target glands and tissues through highly specific binding proteins, called receptors.
The binding of a hormone to its specific receptor induces various change or reactions in the cells.
Most hormones are amino acid and peptide in nature while steroid derived from cholesterol.
Fertility hormone
Fertility hormone is a chemical that is responsible in reproductive system for spermatogenesis in male and ovulation in female. Fertility hormone act differently in male and female.
Type and function fertility hormone in male
| No. | Hormone | Target organ | Function | Circulating level
(normal range) |
| 1 | Follicle-stimulating hormone (FSH) (protein) | Testis | Stimulate production of sperm | Adult: 0.95-11.95IU/L |
| 2 | Luteinizing hormone (LH) | Testis | Stimulate production of testosterone | 0.57-12.07IU/L |
| 3 | Prolactin | None | Inhibit 5 alpha reductase (enzyme that is responsible to catalyst the formation of dihydrotestosterone from testosterone). Hypogonadism in male with hyperprolactenemia is believed due to decreased level of this enzyme. | 72.66-407.4IU/L
|
| 4 | Estrogen
|
Testis
|
spermeogenesis | 40.37-161.48pmol/L |
| 5 | Testosterone | Prostate | Stimulates the spermatogenesis | 5.76-28.14nmol/L |
Note: Normal range is differ from one laboratory to another
Suggested scheme for evaluation of infertile male
An overview of hormonal events related to male fertility
Type and function fertility hormone in female
| No | Hormone | Target organ | Function | Circulating level
(normal range) |
| 1 | Follicle-stimulating hormone (FSH) | Ovary | Maturation of follicle | Follicular – 3.03-8.08IU/L
Mid-cycle – 2.55-16.69IU/L Luteal – 1.38-5.47 IU/L
Postmenopausal: 26.72-133.41IU/L
|
| 2 | Luteinizing hormone (LH)
|
Ovary | Ovulation | Follicular: 1.08-11.78IU/L
Mid-cycle: 7.59-89.08IU/L Luteal:0.56-14.0IU/L Postmenopausal (without HRT): 5.16-61.99IU/L
|
| 3 | Prolactin | Ovary | Lactation
Inhibit secretion of LH and Progesterone from corpus leteum. 1.5 to 20% of women with secondary amenorrhoea and infertile was reported having a high level of prolactin. High level of prolactin was found in female |
108.78-557.13mIU/L |
| 4 | Progesterone | Uterus,
breast |
Progesterone helps prepare the lining of the uterus (endometrium) to receive the egg if it becomes fertilized by a sperm | Follicular <0.3-0.95nmol/L
Luteal 3.82-50.56 nmol/L Post Menopausal <0.3-0.64 nmol/L
|
| 5 | Estrogen
|
uterus | Cellular proliferation and growth of tissues of the sexual organ/related to reproduction | Follicular -77-921pmol/L
Mid cycle-139-2381 pmol/L Luteal-77-1145 pmol/L Post menopausal not on HRT-<36.7-102.7pmol/L Post menopausal on HRT <36.7-528.5 |
Note: Normal range is differ from one laboratory to another
Suggested scheme for evaluation of infertile female
An overview of hormonal events related to female fertility
Extracted from http://www.fertilityinstructor.com/hormones
Blood Sampling for investigation of fertility hormon
Blood Collection for male
No specific time for blood collection
No fasting prior to blood collection
Blood collection for female
Sample should be collected at specific time during menstrual cycle for female.
- Day 3 for LH and FSH
- Day 21 for Progesterone
No fasting prior to blood collection.
Methodology
The measurement of fertility hormone in many clinical setting in Malaysia was conducted by using an automated instrument. Only about 200 microliter plasma or serum was needed to perform the test. The plasma or serum sample was analysed by using an immunoassay method.
References
- Cases in Clinical Pathology, a diagnostic approach fourth edition RN Walmsley, LR Watkinson, HJ Cain
- Jabbour SA. Follicle-Stimulating Hormone Abnormalities. Medscape Reference [serial online]. Jan 3, 2012;Accessed Feb 15, 2012. Available at http://emedicine.medscape.com/article/118810-overview.
- Burris CA, Ash wood ER, Burns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th St. Louis: Elsevier Saunders; 2006:1633:962-967.
- McPherson RA, Matthew R. Pincus MR. Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd Philadelphia: Elsevier Saunders; 2011:254-5.
- Wallach J. Interpretation of Diagnostic Tests. 6th New York: Little, Brown; 1996:717.
- http://www.webmd.com/a-to-z-guides/prolactin
- http://www.nlm.nih.gov/medlineplus/ency/article/003711.htm
- Infertility in men – Diagnosis http://www.umm.edu/patiented/articles/what_causes_of_male_infertility_000067_4.htm#ixzz2WfOT6rjM University of Maryland Medical Center
- How the Male Birth-control Pill Will Work by Stephanie Watson and Cristen Conger
- http://www.fertilityinstructor.com/hormones.html
| Last Reviewed | : | 02 Jan 2016 |
| Writer | : | Suzana bt. Ismail |
| Akreditor | : | Sairi bin Satari |
